James Reilly (Dublin North, Fine Gael)

Section 15.11 of Planning for the Future, published in 1984, was to be Government policy. The specified funds were to be ring-fenced for psychiatric and mental health services, acknowledging the fact that these services represent the Cinderella of our health service and always have done. Under this Government, they remain so, and if it is left in power, this will always be the case. I hope the day is not too far away on which we will have a change of Government, rather than a change of heart on the part of the Minister of State, to the benefit of those who suffer from mental illness.

Perhaps the Minister of State will let us know when the Minister expects to receive the report on Lie of the Land and if it will be publicly available. The proceeds of these sales are not being used exclusively for the provision of mental health services. The Comptroller and Auditor General may have questions to ask about the value for money achieved in regard to certain disposals of psychiatric and mental health institutions. All this is in contrast to the assertion of the former Minister of State, Mr. Tim O'Malley, in the Irish Examiner of Tuesday, 10 August 2004 that despite opposition from the Department of Finance, he had "secured Government assurances that all proceeds from the sale of lands would be ring-fenced for funding of mental health services".

Will the Minster of State explain why the Government failed to secure the 2008 allocation of €25 million needed for the implementation of A Vision for Change? This speaks volumes about the Government commitment to psychiatric services; it is all vision and no change. All of us are aware of the need for more funding. Last year, the Inspector of Mental Health Services, Dr. Susan Finnerty, reported that less than 10% of psychiatric catchment areas were able to offer a range of services to people with mental health problems. She expressed concern that there is no coherent plan for the development of services in the next five years.

An independent monitoring group chaired by Dr. Ruth Barrington reviewed A Vision for Change and found "little evidence to show a systematic approach to its implementation in the first year". The group noted that there was no implementation plan with objective action milestones or deadlines, the absence of which is impeding progress. Meanwhile, the Chief Executive Officer of Mental Health Ireland, Mr. Brian Howard, catalogued a decline in services where, three years ago, there had been 11 suicide resource officers in the State, whereas now there are five. This decline in service is all the more galling given that Ireland has the fifth highest youth suicide rate among 15 to 24 year olds in the EU.

Some weeks ago, the Ombudsman for Children, Ms Emily Logan, criticised the continuing use of adult psychiatric wards for the treatment of children, with children admitted to adult psychiatric wards on more than 200 occasions between December 2006 and December 2007. In 2006, 3,000 children and adolescents waited, on average, 15 months for assessment, with some families waiting as long as four years. Waiting lists were even longer in 2007, with 3,598 children waiting for assessment, one third of whom waited for more than 12 months. In 2008, with no money allocated for the implementation of A Vision for Change, the situation is likely to deteriorate.

The case of the planned psychiatric unit at Beaumont Hospital is an example of the decline in services. It was originally promised more than 20 years ago and was subsequently built. It was used, however, as an overflow area for patients from the medical and surgical wards and now lies full of equipment. A new unit was subsequently proposed and much time and money was spent on its planning. It was sent out to tender in 2005. We have since discovered, however, that a new private co-located hospital is to be built on part of the site. So much for a commitment to mental health services. It is a case of get back to the end of the queue for mental health patients. In the eyes of the Government, which has presided over the health services for the past ten years, they are the least worthy patients. This is because they are the most vulnerable and represent the least threat.

Patients in north and north-east Dublin are still being admitted to St. Ita's Hospital, where there are 24 beds, 23 of which are in an open dormitory. Twenty-three acutely disturbed patients, many of whom are psychotic, are accommodated in a dormitory with only three feet between beds, in a building that was constructed more than 30 years ago. These are Ceausescu-like conditions. Many patients in St. Ita's are kept in chemical strait-jackets and drugged up to their eyeballs, a situation with which most psychiatrists there are unhappy.

I heard recently of a woman in that unit who was assaulted by another patient who had been out on a day pass. This other patient returned to the ward, took her pillow and tried to suffocate the woman in question. It is a tribute to the staff of these units that more patients have not been seriously harmed or even killed. This is no way to treat the most vulnerable in society in what is supposedly the second wealthiest country in the western world. Despite all this, I understand St. Ita's Hospital is operating a two for one staffing policy, that is, for every two members of staff let go, only one is replaced.

There is no mental health service for 16 to 18 year olds in the Swords area. Adult psychiatrists do not feel competent to deal with them and the services for children have insufficient resources to do so. The mental health clinic in Balbriggan is an old prefabricated building with fungus growing on the walls. What would the Health Information and Quality Authority have to say about nurses taking blood from patients in such conditions?

This is how people are being treated in 2008. As she does with every other aspect of the health service, the Minister pays little other than lip service to mental health provision. It is one of the great scandals of the 21st century that some of the most vulnerable in our society are treated in this way. Yet the Government continues to preside over this system. It is time the Minister lived up to her promises instead of consigning the Government's mental health strategy to the rubbish tip.

Mental health services are not the only services that continue to struggle. I was alarmed last week to read an internal HSE memo planning wholesale cutbacks in front-line health services in the north east, including a 25% reduction in orthopaedic and elective surgery in Our Lady's Hospital, Navan, a scaling back of elective surgical activity in Louth County Hospital, a reduction in outpatient clinics in Our Lady of Lourdes Hospital, Drogheda, and elsewhere, elective surgery to take place only four days a week within the Cavan-Monaghan hospital group, the closure of ten beds at Monaghan Hospital and so on. Tallaght hospital is in serious difficulty. The €20 million taken from its budget last year will not be replaced. In addition, it faces a fine of €2.1 million. It is outrageous that the people of Tallaght should suffer because of the ineptitude of the management. In addition, the HSE midland area plan involves a reduction in expenditure of €5 million.

It seems the new year is beginning with the same swingeing health cutbacks that took place in the last months of 2007 and which we were told were only a temporary measure. This should be no surprise given that we were originally told, in the first half of 2007, that there would be no cutbacks. This HSE memo is further evidence that the teamwork implementation project, the details of which were leaked on 14 May last year, is being put into practice. This scheme exposed the Minister's plan to close accident and emergency departments in Monaghan and Dundalk in 2008 and Navan in 2009 on the basis that such actions would present "major opportunities for savings, efficiencies and staff redeployment". Nowhere is there mention of patient welfare.

While the Minister pays lip service to putting patients first, it is telling that both these HSE documents refer to cost efficiencies only and not to patient care. Hospital management is responsible for the hospital budget and it should take the hit rather than patients. Members of management take fat increases in salaries as they try to convince us that they are doing a great job. The reality is that the service is deteriorating. There are no beds for psychotic patients. There was no bed for 39 year old Beverly Seville-Doyle, a diabetic mother of three who died alone in a toilet in an accident and emergency unit at 3 a.m. There is no bed for the mother of seven with a probable brain tumour who must sit at home having mini-seizures. Up to 400 patients wait on trolleys in hospitals throughout the State. The shameful list goes on.

While there are plans to open a medical assessment unit at Our Lady's Hospital, Navan, and elsewhere, the true objective is to strip out services before they are replaced. Last week, I received a copy of a letter by Dr. Finbar Lennon, a consultant at Our Lady of Lourdes Hospital, Drogheda, outlining his view that the hospital is not capable of dealing with the load that will be placed on it. The latest we hear is that the HSE is €370 million short on its estimated expenditure for 2008 before the year has even begun. It is frightening that its solution is to cut back patient services rather than improve efficiencies in its management structures.

The problem with the health service in general is that we have insufficient capacity to deal with the demand. The solution is equally clear. First, we must increase capacity. This can be done by making better use of the beds we have in hospitals. I have alluded numerous times to the 57,000 bed days lost between the Mater and Beaumont last year alone, the equivalent of a 150-bed hospital. These patients could be treated in the community if facilities were available, including physiotherapy, occupational therapy and speech and language therapy. We must also increase capacity by providing more beds. There is no getting away from this requirement. The consulting firm employed by the HSE has told the Minister there is a shortfall of 1,200 beds and that this situation will deteriorate unless we change the way we do business.

The second part of the solution is to reduce demand through prevention. I have called before for the introduction of an age appropriate annual check-up for every man, woman and child. This would allow for the earlier detection and treatment of disease and help prevent costly complications. We must work to prevent the incidence of illnesses such as diabetes and heart disease through education, dietary advice and regular contact between patient and GP. This approach will take time to yield results, but for every euro spent on prevention, there is a €20 saving in terms of treatment costs avoided. The Government must have the political courage and vision to implement such an approach immediately because the benefits will be some time in coming.

The health service has been characterised by failure after failure. The HSE must report immediately on the proposal to reduce front-line services. I ask that the Minister fulfil her Government's promise to implement the recommendations of A Vision for Change, that she request the urgent report from the HSE on the proposal to reduce frontline services, that she ensures, at a time when an additional €1 billion is available to the HSE, that frontline services are not further reduced, that she fulfils her commitment on hospital beds and medical cards, that she gives us a site location map for the new psychiatric unit at Beaumont Hospital to replace the unit in St. Ita's for which we have waited over 20 years, and that she gives us the isolation units and isolation beds for our cystic fibrosis suffers so that they have a fighting chance to live as long as their counterparts on the other half of this island, which is all they want.

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